Clinical and Radiographic Features of Subtypes of Acute Proximal Junctional Failures Following Correction Surgery for Degenerative Sagittal Imbalance.

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Clinical and Radiographic Features of Subtypes of Acute Proximal Junctional Failures Following Correction Surgery for Degenerative Sagittal Imbalance.

World Neurosurg. 2019 Jan 24;:

Authors: Ha KY, Kim YH, Oh IS, Seo JY, Chang DG, Park HY, Min HK, Kim SI

Abstract
OBJECTIVE: To identify clinical and radiographic features of each subtype of acute proximal junctional failures (PJFs) following correction surgery for degenerative sagittal imbalance (DSI).
METHODS: A total of 157 patients with mean age of 68.0±6.3 years, who underwent correction surgery for DSI were included. Acute PJFs were categorized into four forms: fracture at the uppermost instrumented vertebra (UIV), fracture at UIV+1, fixation failure at UIV, and junctional subluxation. Demographic, clinical and radiographic data were analyzed retrospectively.
RESULTS: Eighteen patients presented with acute PJFs. PJF group had significantly lower T-score (-3.3±1.1 versus -1.9±1.5) on bone densitometry and lower body mass index (BMI) (23.0±3.9 kg/m2 versus 25.6±3.7) than non-PJF group. However, radiographic parameters exhibited no significant differences. UIV fracture, UIV+1 fracture, UIV fixation failure, and junctional subluxation were observed in 5, 6, 4, and 3 patients, respectively. Fixation failure developed the earliest (median 1.3 months), followed by UIV fracture (1.5 months). UIV fracture occurred earlier than UIV+1 fracture (36 months). Patients with UIV or UIV+1 fracture had significantly lower T-scores than others. Although BMI and T-score were significant risk factors for overall PJF (P=0.043 and 0.021, respectively), different risk factors for each form of PJFs were identified on separate risk factor analysis.
CONCLUSIONS: Acute PJFs group had lower T-score and BMI. Each subtype of PJFs had different clinical and radiographic features. Although BMI and T-score were associated with overall PJF, each subtype might have different risk factors. Identifying risk factors for each form of acute PJFs might help avoid it.

PMID: 30685377 [PubMed - as supplied by publisher]

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